一位初診斷紅斑性狼瘡青少女個案之護理經驗

The Nursing Experience of Caring an Adolescent Patient with Newly Diagnosed Systemic Lupus Erythematosus

本文是探討一位初診斷紅斑性狼瘡青少女個案之護理經驗，個案因缺乏疾病的正確資訊及住院接受治療而經歷身心痛苦，筆者藉由觀察、會談及門診追蹤訪視，並運用整體性健康評估來收集資料，護理期間自2007年3月7日至3月21日，分析發現個案的健康問題如下：(1)潛在危險性感染，危險因子為顆粒球低下及免疫功能受抑制；(2)知識缺失，與個案及案母對紅斑性狼瘡的疾病知識及治療資訊有關；(3)身體心像改變，與紅斑性狼瘡疾病及治療副作用導致身體外觀改變有關。筆者運用同理心、鼓勵、主動傾聽與個案及家屬建立信任關係，針對其個別性需求提供紅斑性狼瘡的衛教指導，以提升照護知識，採取保護性隔離措施以預防感染，並幫個案化淡妝打扮和綁頭髮，協助個案重建正向的身體心像，藉由減少破壞力與增加建設力的護理措施，提供一個有利於達到身體心像較高整合狀態的情境，促使個案能以正向觀點來看待疾病治療的過程，以提升自信心及自我價值感，最後達到較佳的適應狀態。

This article was to explore nursing experience of caring an adolescent patient with newly diagnosed systemic lupus erythematosus (SLE). Due to lack of information of SLE and delayed treatment in hospitalization, this case experienced physical and psychological suffering during the process. Observation, interview, outpatient department follow-up, and holistic health assessment were used to collect data. The author took care of the patient from March 7 to March 21 in 2007. The major health problems were as follows: (1) potential risk for infection: risk factors were leukocytopenia and immune function suppression; (2) knowledge deficit: lack of information of disease and treatment with SLE; (3) body image change: appearance change because of disease and side effects of medications. The author offered empathy, encouragement and active listening to establish trust relationship with the patient and her family. We provided nursing education of SLE and utilized protective isolation to prevent infection. Besides, the author assisted the case to apply cosmetics and make up and tied up her hair to reconstruct positive body image. By Nursing interventions of decreasing destructive force and increasing constructive force, we provided a situation of achieving integrity status and encouraged the case adopt positive viewpoint to her disease process and promoted her self-esteem so that she could reach better adaptation finally.